Biomedicalisation of death in Bangladesh : An ethnographic study of hope and technology in ICU

Islam, Sadaf Noor and Goodwin, Dawn and Tutton, Richard (2021) Biomedicalisation of death in Bangladesh : An ethnographic study of hope and technology in ICU. PhD thesis, Lancaster University.

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Abstract

The relatively recent developments of life support technologies, which were introduced in Bangladesh in 1978, have resulted in the production of new forms of life and death. The intervention of modern life support technologies gives rise to hope in relatives of patients but led to complexities and contradictions in the contemporary society of Bangladesh. I show how the intervention of life support technologies has resulted in hybridised technologised life and death, new technologised hope and care, and new forms of subjectivities. This thesis examines how ‘decisions’ about initiating life support technologies are made and how hope, the affordance of technologies, and economic context interplay in this endeavour. Life support treatment is very expensive in Bangladesh, where life support care is mostly privatised, and the government life support treatment is not entirely free, thereby, this study focuses on how economic status affects access to different levels of technological intervention and shapes different experiences of death. This thesis examines the influence of a marketised profit-motivated health care service and the paradox of hope in the life support treatment choice. In some cases, relatives need to take the withdrawal decision of life support for not being able to continue the cost of life support treatment. Informed by the unequal access to resources, this thesis finds the process of withdrawal of life support as a negotiation, which also reflects the political-economic context of life support technologies. For the uneven access to resources, I consider that the biomedicalisation of death has taken the form of stratified biomedicalisation. As there is still no state-provided standard guidelines, protocol, and legislation for life support care in Bangladesh, I critically explore how this complicates and impacts the public perceptions of life support technologies. In a critical exploration of the use of life support technologies in both public and private intensive care units in three locations, carried out by anthropological ethnographic observation and conversations, I show the biomedicalisation of death in the context of contemporary Bangladesh. My ethnographic observation in the ICU and daily conversation with relatives, doctors, and health service providers enables me to understand seemingly insoluble tensions that exist in relation to the life-prolonging technology’s relationship to the dying patient’s family members. The anthropological exploration of the biomedicalisation of death in Bangladesh is the firstever study in this area to my knowledge. Thereby this study contributes to the scholarship of medical anthropology of science, technology and body, medical sociology, science, and technology studies as well to the understandings of policy and lawmakers. Providing ethnographic knowledge on the actions of life support technologies in life and death can also contribute to generating knowledge regarding the misuse and futility of life support technology.